Canker Sores

Canker sores (aphthous ulcers) are ulcers that occur on the lips, tongue, palate, gums, and cheeks. A yellow-white membrane covers canker sores in the middle and the redness surrounds them. It is the mucous membranes of the mouth that hurt us while eating and drinking water. Unlike cold sores, canker sores are not contagious and only occur inside the mouth.

Signs and Symptoms

The oral mucosa is a specialized, delicate, thin layer of tissue. When it comes into contact with force, the mucosa can be peeled and damaged. In other words, the oral mucosa is sensitive to erosion and traumatic lesions can easily occur there. Many of the diseases that occur in the mouth, lips, cheeks, tongue, palate, and gingival mucosa occur in the form of canker sores. Aphthous ulcers can be single or multiple, symmetrical or irregular. The center of the aphtha is yellow-white, and the periphery is red and edematous.

The deepening of the erosion in the oral mucosa causes painful ulcers. Therefore, canker sores are usually painful lesions. The reason why they are painful is that the base of the wound goes down to the nerve endings under the mucous membrane.

Types of Canker Sores

The most important thing in aphtha types is the size of the aphthae and how often we see it. Canker sores can occur very often. For example, it may appear more than 3 times a year, sometimes monthly, and disturb the patient.

Minor canker sores

Minor aphthae are the mild form and are the type we see most often. There may be a single or several aphthae in the mouth. Minor aphthae take about 7-10 days to pass. Almost all of them are repetitive.

Major canker sores

Major aphthae can take up to 15 days to 1.5 months. The fact that it takes so long for major aphthae to pass causes the suspicion of malignancy in the mouth. In other words, major aphthae can mimic oral cancers in these aspects. Although we don’t see it much nowadays, it can occur widely all over the oral mucosa. But it is mostly localized in the mouth part of the lip and cheek, palate, gingiva, and tongue.

Herpetiform canker sores

Herpetiform aphthae mimic herpes. In the mouth, we see as small as a pinhead, but in the form of many aphthae. The center of each aphtha is yellow-white with redness around it. They are less common and painful. Herpetiform aphthae can take 7-15 days to pass.

Causes of Canker Sores

The causes of canker sores can be various. In addition, microorganisms in the mouth can infect them. Accordingly, patients with oral aphthae should be very careful about oral hygiene. We can group the conditions that cause aphtha formation, and facilitate its formation, and we see together as follows.

Age and gender

Canker sores are more common in older people. It is slightly more especially in women.

Genetic predisposition

In some patients, canker sores may be familial. For example, sometimes when we investigate, we can see that the patient’s mother, sibling, or uncle also has such sores.

Physical and chemical trauma

Another cause of canker sores is trauma. In other words, lip and cheek bites that will disrupt the integrity of the oral mucosa, teeth or prosthesis hitting, thermal and chemical burns, and hard foods can also cause canker sores. Apart from this, some substances in hygienic products such as toothpaste, which are the products we use most, can also trigger aphthous ulcers. Accordingly, sometimes we can solve the aphtha problem with a simple toothpaste change.

Foods

Some foods burn the mouth and cause aphtha formation. For example, nuts such as hazelnuts and peanuts can cause canker sores in the mouth. Acidic foods and drinks such as citrus fruits, tomatoes, eggplant, vinegar, and pickles can initiate canker sores. Apart from this, very salty, spicy foods and very dry bread can facilitate the formation of canker sores by irritating the oral mucosa. Excessive consumption of tea and coffee can also trigger the formation of aphthous ulcers.

Weakened immune system

Frequent canker sores can be a sign of weakened immunity. We can see recurrent aphthous ulcers frequently in the presence of a disorder such as fatigue, stress, or cancer, which causes a decrease in body resistance, and the case of ongoing chemotherapy treatment against cancer. Some conditions that reduce body resistance such as anemia, iron, ferritin, B12, folic acid, and zinc deficiencies can also trigger canker sores.

Any cause that weakens immunity facilitates the formation of oral aphthae. However, there is no rule that there will be canker sores in the mouth in every case where the immune system is weak. These conditions mostly affect people who have a predisposition to aphthous ulcers.

Diseases

We can see canker sores alone or in combination with many systemic diseases. Especially recurrent aphthae are associated with systemic diseases. The most prominent of these diseases is Behçet’s disease, which is a systemic autoimmune disease.

Behçet disease

It is the most important systemic disease that causes aphtha formation. Because oral aphthae are one of the most basic findings of Behçet’s disease. Therefore, it is necessary to screen patients with frequent mouth ulcers for Behçet’s disease. In Behçet’s disease, oral aphthae do not occur alone. There are other manifestations of this disease as well. In Behçet’s disease, ocular findings, skin, and genital ulcers often accompany oral aphthae. Behçet’s disease is a serious lifelong disease. Accordingly, aphthae caused by this disease need lifelong treatment.

Other diseases

Autoimmune diseases such as lupus erythematosus, Reiter syndrome, PFAPA (periodic fever aphthae pharyngitis and adenitis syndrome), some other diseases such as cyclic neutropenia, HIV, and leukemia can also cause aphthous ulcers. For example, in cyclic neutropenia, neutrophils decrease in a certain cycle and the body’s immune system weakens. In this case, aphthae occur in the mouth. Apart from these, we can see aphthous ulcers in the course of gastrointestinal diseases such as Helicobacter pylori, ulcerative colitis, Crohn’s disease, and some other diarrheal diseases.

Infections

Microorganisms do not cause canker sores and therefore are not contagious like herpes. Although bacterial and viral agents do not directly cause oral aphthae, aphtha-like lesions may occur in the mouth under their influence. In these cases, the treatment includes the use of antibiotics and antiviral drugs.

Smoking

Smoking and quitting smoking can also cause canker sores. Canker sores may occur in some people after a while, especially in cases of quitting smoking. Smoking creates a light keratinization layer on the oral mucosa. In this case, the resistance of the oral mucosa against external factors (traumas, viral agents, infections) increases a little more. When you quit smoking, the keratinization layer in the mouth begins to disappear. Therefore, the oral mucosa returns to its former state and becomes more sensitive. In these cases, nicotine gums are recommended for smokers. Nicotine gums create a little keratinization layer in the oral mucosa and the mucosa becomes a little more resistant.

Other causes

Some drugs (eg, ACE inhibitors), hormonal changes, poor oral hygiene, and dental caries can also cause canker sores. However, in some patients, canker sores may occur even though no cause can be found.

Diagnosis for Canker Sores

We see canker sores in approximately one out of every five people in society. The aphthae caused by many diseases in the mouth are very similar to each other. Therefore, their differential diagnosis is important in terms of treatment. In this respect, patients may need an examination not only by dentists but also by medical doctors. Because up to 200 diseases, especially systemic diseases, can cause findings in the oral mucosa.

Canker Sore Treatment

For now, no vaccine, drug, or method will cure the canker sores immediately or prevent them from occurring in the future. In this respect, pain control, wound treatment, diet regulation, and some measures to reduce the recurrence of aphthous ulcers are at the forefront of canker sore treatment. However, eliminating the cause of the aphthae will be the first step of treatment.

Antibiotics, anti-inflammatory drugs, immunomodulatory drugs, pain relievers (eg, ADA approved; Kank-A Mouth Pain Liquid, Benzodent Maximum Strength Pain Relieving Cream, etc.), silver nitrate pens, mouthwash (eg, ADA-approved; Listerine Ultraclean Antiseptic Mouthwash, etc.), and alternative solutions (echinacea, Vit B, Vit C, zinc gluconate, etc.) are used in the treatment of aphtha. For example, we cauterize the wound area with a silver nitrate pen because these sores are very painful. When it is cauterized, it becomes necrosis, its conduction with the nervous system is interrupted, and therefore aphthae do not hurt.

Remedies

There is not much we can do at home that directly relieves the pain of canker sores. However, some methods provide quick healing of mouth ulcers and relieve pain. These are mouthwash made with carbonated water and saltwater. For example, home treatment can be done by taking a sip of this mouthwash 3 times a day, gargling for 3-5 minutes, keeping it in the mouth, and spitting it out.

Some antiseptics, analgesic mouthwash, sprays, or cortisone-containing ointments sold in pharmacies can be used against canker sores. All these generally relieve the pain of sores in the mouth. Apart from these, special mouthwash with special painkillers added can also be prepared by the doctors. These special mouthwashes are one of the more effective remedies for relieving pain.

Conclusion

It is necessary to use products that reduce pain and accelerate healing for aphthous ulcers. It is important to clean the wound by using the mouthwash recommended by the doctor, as the residues left on the wound after eating delay the healing of the wound. Apart from this, it is inconvenient to tamper with canker sores too much. Otherwise, other infections may be added to them and cause a more severe picture. Moreover, if recurrent aphthae are not treated, they can turn into diseases that can lead to brain inflammation.